Preliminary Questionnaire

Today's Date

FAMILY INFORMATION

Marital Status *

Spouse's Information

Dependent's Name(s) & Age(s) ex: John (10)

Property *

Investments *

Retirement *

Business Assets

Insurance

Disability Insurance

Does your Insurance continue to fill a need?

Yes No I Don't Know

Do you work closely with an insurance agent?

Yes No

Liabilities *

Explain Personal Loan or Other Liabilities:

Living Expenses (not including above liabilities) *

Income *

Current Estate Plan *

*

Do you have an Estate Planning Attorney? *

Yes No

Is your Attorney a key decision maker for you? *

Yes No

Would you like us to recommend someone? *

Yes No

Is your CPA a key decision maker for you? *

Yes No

Do you feel you have achieved financial security? *

Yes No

How would you like to pass your estate? *

Do you have any potential inheritance? *

Yes No

If yes, please explain:

Do you plan to leave any portion of your estate to charity? *

Yes No

Do you need to make any special financial provisions for any member of your family? *

Yes No

If yes, who?

Are you willing to invest effort/money, if plan serves to reduce /eliminate tax? *

Yes No

What is your Risk Tolerance?

0 = Conservative, 50 = Moderate, 100 = Aggressive

What is your primary reason for investing?

What are you looking for in a financial advisor?

When deciding how to invest your money, which do you care about more?

The global stock market is often volatile. If your entire investment portfolio lost 10% of its value in a month during a market decline, what would you do?

When I invest money, I am:

1. If you own a home, do you have more than 30% equity? *

2. Do you plan to work during retirement? *

3. From an original investment of $150,000, your portfolio is now worth $250,000 suddenly declines by $37,500 or 15%, which best describes your response? *

4. Your portfolio, from previous question, is now worth $210,250 suddenly declines by $21,025 or 10%, which best describes your response? *

5. Have you invested in Equities? *

6. Have you invested in Fixed Incomes? *

7. Have you invested in Mutual Funds? *

8. Have you invested in Options, Futures or Derivatives? *

9. How would you describe your level of investment knowledge? *

10. How much investment experience do you have? *

11. Do you currently need to withdraw from your investments to provide income? *

12. How soon do you expect to withdraw from these assets to provide retirement income? *

Configurable list *

Thank you for completing this questionnaire.

If you have not yet scheduled an appointment, someone from our office will contact you, upon receipt of your questionnaire. We offer appointments form 9am - 5pm, M-F.

Please indicate your appointment preferences below:

Monday Tuesday Wednesday Thursday Friday

Earliest Appointment Morning Lunch Hour Mid Afternoon Latest Appointment Anytime

We look forward to talking with you soon.

Should you have questions or concerns, feel free to give us a call.

If you have account statements, a budget, or other documents you wish to review with the advisor please email it 2 days prior to your meeting to jkulikowski@colonialtrust.com

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